Delta variant, breakthrough infections and related consequences

[Alex_Krycek]

7 hours ago, CharonY said:

There are a wide range of treatment options that have been developed. However, except for vaccine there is none that prevents getting sick.

Yes, but there are numerous treatments that greatly reduce the severity of the illness and chances of hospitalization.  Perhaps countries should begin shifting away from a "zero Covid" strategy that relies only on vaccination.  

https://asia.nikkei.com/Spotlight/Coronavirus/COVID-19-pill-for-at-home-treatment-in-trials-by-Japan-s-Shionogi

Edited August 19, 2021 by Alex_Krycek

[swansont]

1 hour ago, Alex_Krycek said:

Yes, but there are numerous treatments that greatly reduce the severity of the illness and chances of hospitalization.  Perhaps countries should begin shifting away from a "zero Covid" strategy that relies only on vaccination.  

Which countries are implementing a vaccination-only strategy?

And what is the cost of treatment vs vaccine?

13 hours ago, TheVat said:

In any case,  I'm skeptical of Biden's assertion that the US can do this without diverting doses away from the unvaxxed. 

The US is throwing out expiring doses, which indicates supply exceeds demand.

here's what's happening all across the United States: Millions of vaccine doses at risk of spoiling are sitting on freezer shelves, with no easy way to get them to countries desperately waiting for shots.

https://www.npr.org/sections/goatsandsoda/2021/08/10/1025463260/alabama-just-tossed-65-000-vaccines-turns-out-its-not-easy-to-donate-unused-dose

[TheVat]

1 hour ago, swansont said:

 

The US is throwing out expiring doses, which indicates supply exceeds demand.

here's what's happening all across the United States: Millions of vaccine doses at risk of spoiling are sitting on freezer shelves, with no easy way to get them to countries desperately waiting for shots.

https://www.npr.org/sections/goatsandsoda/2021/08/10/1025463260/alabama-just-tossed-65-000-vaccines-turns-out-its-not-easy-to-donate-unused-dose

Am aware.   My point was somewhat muddled by insufficient context -- I wasn't suggesting that we could skip boosters and ship aging doses to Africa (especially unfeasible with Pfizer) ... rather,  I meant that promoting boosters would divert effort from getting the rest of our unvaxxd populace educated and vaccinated.  And globally,  might require larger shipments from pharms that would better be sending those fresh doses to Africa et al.  

However,  on further thought,  it may be better to promote the short shelf-lifed Pfizer for boosters where it's clear the VAX "hesitant" (that's the nice term,  mine would be NSFW) are simply not going to get the near-expired doses sitting in Walgreen's, and so they may as well do some good elsewhere.   Then,  the more hardy Moderna vax could be shipped in larger quantities to places like Africa where deepfreezes are thinner on the ground.   

Edited August 19, 2021 by TheVat
fetish

[swansont]

15 minutes ago, TheVat said:

Am aware.   My point was somewhat muddled by insufficient context -- I wasn't suggesting that we could skip boosters and ship aging doses to Africa (especially unfeasible with Pfizer) ... rather,  I meant that promoting boosters would divert effort from getting the rest of our unvaxxd populace educated and vaccinated. 

My point was that if we have expiring doses then there is no current shortage. And there likely will be no shortage any time soon, because in the early stages of the vax effort one constraint was manufacturing capacity, which was still ramping up. So there should be no problem. The US hit a goal of 100 million doses in Biden's first 100 days, and that was back-heavy, because the delivery in Jan/Feb was lower - the allocation for Pfizer was ~ 2 million doses a week. That quickly ramped up to 5 million per week by the end of March.

Anyone in that first cohort needing a second dose would only take 40% of that capacity, leaving millions of doses for the currently unvaccinated.

(Pretty sure there is a similar trend for the other options)

[CharonY]

12 hours ago, iNow said:

To be clear, we’re in violent agreement around the logic of this one. We need the whole world vaccinated or we all suffer collectively. No quarrel. 

I’ve also watched politics and economics long enough to know that avoiding a 3rd shot booster in the US isn’t going to magically send extra doses to those areas most in need of their 1st.

Those countries are lacking shot number 1 due to issues unrelated to the US deciding to offer shot #3 to its citizens (damned near half of whom haven’t even bothered taking shot 1 despite the absolute lack of cost, complexity, or obstacle in doing so).

I also want the world vaccinated. I don’t think lack of vaccine supply is the driver of it not happening. I’m essentially struggling with the idea that boosters in the US are the primary barrier to achieving that global vaccination we both agree is desperately needed, especially given all of the vaccines being produced in China, Russia, and elsewhere.  

I think we are in agreement, though I am shifting perspective a little bit here. I will preface that by acknowledging that my position is extremely hypocritical as I have benefitted from the current strategy myself. But the broader issue here is not so much how much capacity is really being diverted, but rather one of overall strategy. Rich countries have implemented local strategies, prioritizing their own citizens over the world and thereby effectively implementing an outbreak rather than a pandemic strategy. The fact that folks are even thinking about a broader implementation of booster shots despite somewhat limited data regarding need and efficacy is more a symptom than a cause of existing vaccine inequality. A moral argument is made here for example: https://www.bmj.com/content/374/bmj.n2027

 

But aside from that, if we step back and ignore our own needs and fears for a second, we would clearly acknowledge that as a world-wide strategy, vaccinating for example frontline and essential workers on a world-wide scale it would have reduced overall loss of life. This is especially tragic for poorer countries who have shut down already struggling economies in order to contain the virus and now get all the new variants unleashed on them without the ability to recover. I.e. if we had a centralized strategy many of us may not have been vaccinated yet. However, we may be in a better position to prevent or reduce the incoming humanitarian catastrophe (and new variants).

6 hours ago, Alex_Krycek said:

Yes, but there are numerous treatments that greatly reduce the severity of the illness and chances of hospitalization.  Perhaps countries should begin shifting away from a "zero Covid" strategy that relies only on vaccination.  

https://asia.nikkei.com/Spotlight/Coronavirus/COVID-19-pill-for-at-home-treatment-in-trials-by-Japan-s-Shionogi

I think few countries implemented a zero COVID-19 strategy and if they did, the primary means were lockdowns, not vaccination. The idea of vaccination was originally to get herd immunity, but that was already very unlikely when the UK variant (B.1.1.7 or Alpha) came out and at this point I doubt that there a lot of folks believing in it anymore. The issue with treatments is that you alleviate symptoms and therefore do not prevent spread or creation of new mutants. I.e. it would not be part of COVID-19 reduction but one of mitigation. 

As you may have noticed, key strategies other than vaccination have been hygiene, distancing and masks.

[iNow]

6 hours ago, swansont said:

The US is throwing out expiring doses, which indicates supply exceeds demand.

And it’s even worse in Iowa than in Alabama (which was the focus in your link)

1 hour ago, CharonY said:

if we had a centralized strategy many of us may not have been vaccinated yet. However, we may be in a better position to prevent or reduce the incoming humanitarian catastrophe (and new variants)

Again, agree completely. National borders and archaic tribal tendencies, however, mean few (if any) counties are currently coordinating in this way.

Your strategy is good, but it lacks a coherent mechanism for getting it operational IMO. The WHO and UN have no authority to force sovereign countries to proceed in this manner, nor are countries volunteering to do so by choice. 

Edited August 19, 2021 by iNow

[CharonY]

1 hour ago, iNow said:

Your strategy is good, but it lacks a coherent mechanism for getting it operational IMO. The WHO and UN have no authority to force sovereign countries to proceed in this manner, nor are countries volunteering to do so by choice. 

Yes, unfortunately that is what the current pandemic has exposed. In fact, many countries struggled with figuring out coherent strategies within their borders. Part of my disappointment is that it does not seem that we are learning and/or developing better strategies to prepare us for the future. Instead, it feels like much more energy is being invested in finger pointing as if that would change reality somehow.

[iNow]

I share your disappointment. My state won’t even allow the school to mandate masks. And parents are thanking them for it. Because masks are child abuse. And freedom! Or something. 

Edited August 19, 2021 by iNow

[beecee]

44 minutes ago, iNow said:

I share your disappointment. My state won’t even allow the school to mandate masks. And parents are thanking them for it. Because masks are child abuse. And freedom! Or something. 

In Australia, masks are already mandated in many states and now accepted.

QANTAS has already announced mandated vaccinations for all its staff, air and ground. And it's pretty certain within the next day or two, our federal government, with state governments support, will be also mandating vaccinations for all frontline workers, including health and teaching.

Australia and New Zealand have been a vicitm of their own early successes, and did not obtain or promote sufficiently hard enough, the necessity of vaccination, nor the availability of supply. That thankfully is now changing and vaccinations are proceeding at good rates, such that we hope for 80% total vaccinations by November.

We already penalise parents that do not have their children fully immunised with the usual infant and child vaccines, with refusal into kindagartens and certain government support, I hope that hardline approach in time, apply to covid19, and the idiotic anti vaxxers, so called freedom fighters. Freedom fighters? what a bloody joke!! 

Edited August 19, 2021 by beecee

[beecee]

Had to have a good laugh at the "attempted protest march" in Sydney yesterday...all roads in were blocked and only a couple of hundred made it. One young sheila was carrying a sign with "SAY NO TO VACCINATION PASSPORTS!" sprawled on a piece of cardboard. These will probably be our next step when the current lockdown ends. Only those with vaccination passports will be allowed to travel inter-state/over-seas, and allowed into clubs, pubs and bars.

Another young one was arrested for foul language and started shouting as she was lead away...."It's all a hoax, there is no virus!!" 🤕  Sad, more then anything else, that anyone can be so lead by the nose to accept such conspiracy nonsense.

Sadly these gatherings in Sydney are thought to be inspired and promoted by over seas concerns.

Edited August 22, 2021 by beecee

[StringJunky]

On 8/19/2021 at 11:31 PM, iNow said:

I share your disappointment. My state won’t even allow the school to mandate masks. And parents are thanking them for it. Because masks are child abuse. And freedom! Or something. 

I don't think freedom to harm others is in the Constitution, they should realize.

[iNow]

23 minutes ago, StringJunky said:

I don't think freedom to harm others is in the Constitution, they should realize.

And yet here we are, arguing with people who think masks are more dangerous than Covid and who while frothing at the mouth attack doctors and teachers in parking lots outside of school board meetings for daring to suggest otherwise. 

[Sensei]

On 8/5/2021 at 6:35 PM, CharonY said:

But also from the political side of things I am worried that folks in several areas are winding down tracing (even it it seemed to be done only halfheartedly in the first place) and testing. So we are going to run blind into a new situation, which is rather incomprehensible to me

ln democratic countries politicians want/must to follow voice of the voters. Making unpopular movements (even good at the end for the community) is straight route for being eliminated in the next election. Not without a reason POTUS do more unpopular actions in their 2nd term than in 1st term.

Even worse if such antivaxxer, disbeliever in Covid-19 or human made climate change, take a seat becoming influential politician.. such a person will reverse everything good what was done (e.g. withdrawal from the Paris Agreement)..

7 hours ago, StringJunky said:

I don't think freedom to harm others is in the Constitution, they should realize.

They were brainwashed that COVID-19 is a hoax. I met such people (when they were returning from anti-lockdown protests) and talked with them face-to-face.. Showing them this video:

 

..imagine what disaster can make such anti-lockdown politician after being elected..

Edited August 22, 2021 by Sensei

[beecee]

19 hours ago, iNow said:

And yet here we are, arguing with people who think masks are more dangerous than Covid and who while frothing at the mouth attack doctors and teachers in parking lots outside of school board meetings for daring to suggest otherwise. 

 

13 hours ago, Sensei said:

Even worse if such antivaxxer, disbeliever in Covid-19 or human made climate change, take a seat becoming influential politician.. such a person will reverse everything good what was done (e.g. withdrawal from the Paris Agreement)..

They were brainwashed that COVID-19 is a hoax. I met such people (when they were returning from anti-lockdown protests) and talked with them face-to-face.. Showing them this video:

What drives these people? Is it their ignorance of science and the scientific method? Is it the feeling that they are somehow open to some truth, that is hidden from us normal folk? Does that belief in conspiracies make them feel powerful and knowledgable? Is this why in many circumstances, [mainly being in the minority] that they see the need for violence? How much of a role does religion play with these conspiracy pushers? 

I forgot to mention, a bloke in one of the Sydney/Melbourne marches [forget which] had on a Donald Trump hat! 

11 minutes ago, beecee said:

 

What drives these people? Is it their ignorance of science and the scientific method? Is it the feeling that they are somehow open to some truth, that is hidden from us normal folk? Does that belief in conspiracies make them feel powerful and knowledgable? Is this why in many circumstances, [mainly being in the minority] that they see the need for violence? How much of a role does religion play with these conspiracy pushers? 

I forgot to mention, a bloke in one of the Sydney/Melbourne marches [forget which] had on a Donald Trump hat! 

Finally, who are more likely to accept/believe or fall for conspiracy nonsense...those on the extreme right? on the extreme left? Please don't get me wrong, I'm not for one minute suggesting that we should uncritically accept things that politicians say...far far from it!! I'm saying that we still want them [politicians] to be discerning/thoughtful and considerate of all, but that all elected leaders be held accountable.

[iNow]

3 hours ago, beecee said:

What drives these people?

I believe it’s the same things that drove the Nazis. Answer that and you can answer this. 

[beecee]

20 hours ago, iNow said:

I believe it’s the same things that drove the Nazis. Answer that and you can answer this. 

Not sure its the same thing. Hitler and the Nazi movement was driven by hate, extreme Nationalism, and extreme propaganda taught as fact in their schools. What drives the conspiracy pushers and anti vaxxers, seems in the first to be more of a rebellion against society, and taking the opposite or conspiracy tact just for the sake of it, and taken to such a degree, that they end up believing their nonsensical approach themselves. Both of course see violence as a part of their political agenda, as being the only means [in their minds] of pushing their systems onto society in general.

On second thought, there does appear to be a similarity.

 

[CharonY]

7 minutes ago, beecee said:

Not sure its the same thing. Hitler and the Nazi movement was driven by hate, extreme Nationalism, and extreme propaganda taught as fact in their schools.

Well, that was later after the Nazis got to power. Before, they were considered a loud, belligerent but controllable fringe. Especially in the early days, Nazi rhetoric was dominated by anti-establishment (including anti-business themes, which were very popular among the workign class) rhetoric, which, after they got closer to the established right-wing parties got increasingly dominated by anti-semitic and anti-Marxist rhetoric. 

That all being said, I think it goes a tad off-topic here.

[beecee]

https://www.abc.net.au/news/2021-08-24/woman-charges-through-wa-border-rams-police/100401858

A 47-year-old woman has been remanded in custody to serve 14 days’ quarantine after allegedly speeding through a checkpoint at Western Australia’s border with South Australia and ramming a police car.

Just after 10 o’clock Monday morning, Brenda Elena Bleazard allegedly led police on a dramatic high-speed chase while driving a Volvo wagon and towing a caravan.

Police said she reversed her caravan at speed into a police car, tried to run over an officer who was approaching her car on foot and threw a large jar full of petrol at an officer before trying to light it on fire.

Ms Bleazard, of no fixed address, appeared in the Kalgoorlie Magistrate’s Court on Tuesday via audiolink from the lock-up at Eucla police station.

She declined help from Legal Aid WA and represented herself in court. She was not required to enter a plea.

In an exchange with the magistrate, Ms Bleazard requested an interpreter while speaking perfect English.

“I need an interpreter … I don’t understand what you’re talking about,” she said.

Magistrate Andrew Matthews explained she was facing eight charges, including two counts of reckless driving to escape pursuit by police.

She replied by asking: “Can I charge the police?”

While the charges were read to her, Ms Bleazard repeatedly interrupted Magistrate Matthews and told him she did not believe in the judicial system and demanded to be released so she could “immigrate overseas”.

The officer in charge of Eucla police station, Senior Sergeant Russell Chamberlain, could be heard on the audiolink twice trying to get Ms Bleazard to cooperate.

“You need to show him a bit of respect,” he said, referring to Ms Bleazard’s attitude towards the magistrate.

Magistrate Matthews did not consider a bail application, saying he had concerns about Ms Bleazard’s ability to comply with any conditions imposed by the court.

She will be in quarantine — most likely at Eastern Goldfields Regional Prison — until September 6.

She’s doing a good job of a nutter’s defence.

[Alex_Krycek]

Quite a troubling article about Israel's current situation.  They were almost exclusively vaccinated with Pfizer and are now seeing a surge in cases.

“I don’t want to frighten you,” coronavirus czar Dr. Salman Zarka told the Israeli parliament this week. “But this is the data. Unfortunately, the numbers don’t lie.”

https://www.thedailybeast.com/ultra-vaccinated-israels-debacle-is-a-dire-warning-to-america

[CharonY]

13 hours ago, Alex_Krycek said:

Quite a troubling article about Israel's current situation.  They were almost exclusively vaccinated with Pfizer and are now seeing a surge in cases.

“I don’t want to frighten you,” coronavirus czar Dr. Salman Zarka told the Israeli parliament this week. “But this is the data. Unfortunately, the numbers don’t lie.”

https://www.thedailybeast.com/ultra-vaccinated-israels-debacle-is-a-dire-warning-to-america

That is to be expected. As I outlined in OP the vaccines do not fully protect from infection. As such, big unmasked gatherings without social distancing will further the spread of the virus even in a vaccinated population. They are, however, protecting from serious illness, which is the major goal of vaccines. 

A big issue is that for some folks this distinction is lost and sometimes poorly communicated. Immediately lifting restrictions once a certain vaccination threshold has been reached is, in my opinion, premature, as we do not have all the data in yet for proper risk assessment related to health burden in vaccinated folks. 

Fundamentally we are looking at balancing various risks and they require somewhat different approaches.

The most critical one is reducing critical illness and death. For now, the mRNA vaccines seem to be the most effective measure to prevent these events. Challenges are unvaccinated folks who are at higher risk. Additional management is done by a variety of treatment options to reduce severity, though obviously those are less effective than vaccinations.

A second challenge is to minimize infections (or conversely, thinking about how much infection we are comfortable with). The reason why we want that is to reduce the rate of new variants but also because even in a largely vaccinated population some folks may still become ill (though again, unvaccinated folks are at a vastly higher risk). This is much harder to achieve at this point, given that vaccinations are much less effective in preventing infections as they are in preventing disease. Here, additional measures, including isolation and masking are needed in addition to vaccines.

Then there is the big unknown of long-term COVID-19 symptoms, and how protective vaccines are against them. 

At one point or another we need to figure out what the overall risks of opening, unmasking etc. are given a particular achievable vaccination rate (and potential availability of new, potential seasonal vaccines). But until then it is IMO a mistake to assume that we can just pretend that the virus is gone.

Edit: that is actually also a very local perspective as globally we are still looking at a relatively poor vaccination rate, meaning we do have a large potential reservoir for the virus and the rise of new variants.

[PhilGeis]

The disease will progress through unprotected populations.  To the extent there is an effect re. masks, banning mass gatherings, distancing etc., it will be transient and certainly less effective vs delta than the questionable impact on the initial strain.

Vaccination is the most effective control measure for limiting infection and exp. severity of disease.    

[CharonY]

6 hours ago, PhilGeis said:

Vaccination is the most effective control measure for limiting infection and exp. severity of disease.    

As a single measure, sure. However, especially spread of infection can be improved by additional measures. I.e. vaccination should be the baseline, but we can add layers of additional protection.

In a range of regions with Delta dominant and at least decent vaccination rates we do see an increase in cases once restrictions end and often spikes associated with large events.

Of course vaccinations are the main tool and especially for prevention severe disease it is excellent. The main question here is whether we also want to keep infections low and what we need to do to achieve that. 

[swansont]

On 8/25/2021 at 6:31 AM, Alex_Krycek said:

Quite a troubling article about Israel's current situation.  They were almost exclusively vaccinated with Pfizer and are now seeing a surge in cases.

“I don’t want to frighten you,” coronavirus czar Dr. Salman Zarka told the Israeli parliament this week. “But this is the data. Unfortunately, the numbers don’t lie.”

https://www.thedailybeast.com/ultra-vaccinated-israels-debacle-is-a-dire-warning-to-america

Unfortunately they don't actually break down the numbers of vaccinated vs unvaccinated people in the hospital, and dying.

This article says 59% of the patients are vaccinated. If my math is correct, this means that being unvaccinated means you are ~2.75x more likely to be in the hospital as a vaccinated person.

[TheVat]

I've tended to rethink the risk as I become aware that the definition of "serious illness" is not always agreed upon between pundits, pols, and scientists.  This morning I heard a health official point out that the CDC et al. are using the term to mean "needing hospitalization and ventilation assistance," whereas many people tend to think that, if they get sick with a breakthrough infection and are in bed at home for a week and can barely cross the room, that is also a fairly serious illness.  Some of them don't understand, as a result of this confusion of nomenclature, that even when they are vaccinated they may get quite sick and have their life adversely affected (with some chance of lingering myocarditis and other nastiness).  Just because the chances of serious illness (in the CDC definition) are quite small, doesn't mean there isn't a more substantial chance of having quite a nasty bout.   And of doing a bit of virus shedding that gives others a similar ordeal.

FB really needs to find its moral compass (something better than "move fast and break things," Zuckerboy) and start enforcing rules against disinformation and ideological propaganda. 

 

[CharonY]

8 minutes ago, TheVat said:

I've tended to rethink the risk as I become aware that the definition of "serious illness" is not always agreed upon between pundits, pols, and scientists.  This morning I heard a health official point out that the CDC et al. are using the term to mean "needing hospitalization and ventilation assistance," whereas many people tend to think that, if they get sick with a breakthrough infection and are in bed at home for a week and can barely cross the room, that is also a fairly serious illness.  Some of them don't understand, as a result of this confusion of nomenclature, that even when they are vaccinated they may get quite sick and have their life adversely affected (with some chance of lingering myocarditis and other nastiness).  Just because the chances of serious illness (in the CDC definition) are quite small, doesn't mean there isn't a more substantial chance of having quite a nasty bout.   And of doing a bit of virus shedding that gives others a similar ordeal.

FB really needs to find its moral compass (something better than "move fast and break things," Zuckerboy) and start enforcing rules against disinformation and ideological propaganda. 

 

I found that this is a general issue throughout the pandemic. Media and the broader population tend not to check definitions (it is down to individual journalists and I have quite mixed experiences) and often if we explain it, it sometimes to get cut to the juiciest soundbites. Sometimes they do interview medical experts who explain things in more depth, but those bits rarely reach a broad audience it seems.

But serious illness almost always translates to hospitalization, whereas symptomatic can range from cough to debilitating joint pain (but no need for hospitalization). The are qualifiers such as "mild" to "severe" symptoms but I admit, it can be confusing and certain points such as the difference between infections and illness can be easily lost.

To me, a big question still is long-term effects. There is a recent study in the Lance, which is quite interesting in that regard https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01755-4/fulltext

However, they focused on hospitalized cases and other studies which were using more indirect methods (e.g. insurance claims) still found that a sizeable proportion of non-hospitalized COVID-19 patients who appear to suffer from long-term negative effects.

What I mean is that instead of thinking binary about the situation (e.g. hospitalization , death etc.) we need at some point start shifting toward understanding overall health burden. I.e. how much quality of life do we risk when getting infected even with vaccination, for example.

That being said, considering the state of the world priority still must be vaccination.